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What It’s Like to Work at an Abortion Call Center
Amid growing abortion restrictions, the relationship between phone advocates and clients is a mix of customer service and counseling
On a nondescript street in Cherry Hill, New Jersey, sits a squat one-story building, the kind found in suburban office parks around the country. Past its doors is a maze of rooms with walls painted in welcoming shades of pink, purple, and yellow. In the heart of the operation, a group of workers sit in their cubicles, taking phone calls from clients around the country — and, on occasion, around the globe.
The staff are not offering tech support or assisting someone in tracking down a lost package. They’re helping the many clients of the Women’s Centers — a network of five abortion clinics located in New Jersey, Connecticut, Pennsylvania, and Georgia. This particular Cherry Hill office is known as the Advocacy Center, where people around the U.S. call to schedule their abortions and ask questions about the procedure. These conversations can get complicated quickly. Over the course of a call, phone advocates (as they call themselves) help clients address potential barriers to getting the procedure, which can include figuring out when and where the abortion will take place, how it will be paid for, and how the client will get to their appointment.
The people who work at the Advocacy Center come from a variety of backgrounds. Some are fresh out of high school and others are grandparents. Some, like Dax Ebaben, have been lifelong advocates for reproductive rights. Others, like Joharys “JoJo” Torres-Cruz — who applied to work at the Advocacy Center while looking for jobs that would prepare her for medical school — only discovered their passion for the cause after getting the job. Kayla Jones, who worked as a case manager prior to starting at the Advocacy Center in July, is a devout Christian tasked with getting low-income clients funding for their procedures. The lead phone advocate, Lucian, who asked that their last name be withheld, first learned of the call center through their work with the South Jersey chapter of the Democratic Socialists of America and quit their job in retail for the role.
The relationship between phone advocates and clients is a special one, a unique interaction that mixes customer service with advocacy and, at times, counseling. An advocate is often the first person a client reveals their pregnancy to; in some cases, they’re also the first person who hears about an experience of sexual assault or abuse. And yet the relationship between advocate and client doesn’t extend beyond their interaction on the phone: The advocates will never meet the person on the other end of the line. More often than not, they’ll never know what happened to the person after they had their procedure. But as fleeting and ephemeral as these calls might feel, they’re an essential service for people getting abortions — one that’s becoming increasingly critical as anti-abortion laws continue to pass and the fate of Roe v. Wade hangs in the balance.
Amanda Kifferly, the Women’s Centers’ vice president for abortion access, says the need for a centralized call center solely dedicated to addressing the barriers faced by people pursuing abortions became urgent starting in the early 2010s, as the frequency of anti-abortion regulations (commonly known as targeted regulation of abortion providers, or TRAP, laws) increased.
“The number of laws popping up in every state was so confusing to patients,” says Kifferly.
Not long after the Advocacy Center’s grand opening in the fall of 2012, Hurricane Sandy struck the Eastern Seaboard, devastating New Jersey and leaving a number of Women’s Center clients concerned about their appointments. “We really quickly learned that whenever there’s a natural disaster, it’s important to be accessible to those folks [who have been affected],” Kifferly says, noting that phone advocates often become experts on regional travel in order to help people better navigate their route to the clinic.
It’s not just natural disasters that ramp up the Advocacy Center’s call load. In the wake of the 2016 election, the office saw a significant uptick in calls from clients who said they were terrified that the end of Roe v. Wade was imminent; after Georgia passed a law banning abortions after six weeks, a similar surge of calls came in from clients in Southern states. When Immigration and Customs Enforcement (ICE) raids are in the news, the Advocacy Center experiences an increased number of calls from undocumented people whose abortions feel significantly more urgent. (The Advocacy Center currently employs several Spanish/English bilingual advocates. Kifferly hopes to expand their team to include advocates who can converse with Chinese, African, and Russian immigrants in their native languages as well.)
Now entering its seventh year of operation, the Advocacy Center is open seven days a week, including many holidays, with extended hours on Saturday — the day social services and doctors’ offices are most likely to be closed. On snow days, advocates phone into the system remotely. Over the past year, the Advocacy Center fielded over 200,000 calls.
The types of issues Advocacy Center employees troubleshoot depend on clients’ needs. Although some calls are relatively straightforward, involving little more than scheduling the appointment and ticking off a few required checkboxes, most are complex. Many people don’t know how they’re going to pay for their abortions, an issue that’s exacerbated in states where the Hyde Amendment — a measure banning federal funding for abortion — prevents Medicaid from covering it. In Pennsylvania, for example, Medicaid will only cover an abortion in the cases of rape and incest, which in practice means that survivors of rape and incest must “prove” their trauma to the state before being accessing coverage.
Even in states where the Hyde Amendment has been overturned, there are limitations to what Medicaid will cover. In New Jersey, the program only pays for surgical (not medication) abortions, limiting the agency that Medicaid recipients have over their abortion experiences. And people with private insurance don’t necessarily have it better: Under many plans, abortion coverage is limited or nonexistent. “What is the point of having affordable health care if you can’t use it?” laments Jones.
“Many of the call center workers say the most challenging part of the job is the moments when, due to state laws, they are forced to be a barrier to access for the patients they’re eager to help.”
Fortunately, in cases where clients have limited funds, phone advocates have resources to turn to. Programs like the National Network of Abortion Funds provide significant amounts of financial support. As part of their work, advocates take on the burden of applying for these funds on behalf of their clients, who may feel overwhelmed by the forms they’re required to fill out.
In New Jersey, where abortions are allowed up to 24 weeks, a procedure at that point in the pregnancy can cost upwards of $3,000. “We’ve gotten almost the full $3,000 [for a single patient],” says financial coordinator Olga Montes, explaining that combining the available funds from a collection of different programs can often result in an abortion that’s completely covered.
Many of the call center workers say the most challenging part of the job is the moments when, due to state laws, they are forced to be a barrier to access for the patients they’re eager to help.
When someone schedules a procedure at the Atlanta Women’s Center, for example, a Georgia law called the Woman’s Right to Know Act requires that phone advocates read through a script that emphasizes (and, many argue, overstates) the potential medical and psychological risks of abortion and reminds the caller that, should they carry the pregnancy to term, the person who impregnated them will be held responsible for child support.
As one of the Advocacy Center’s bilingual advocates, Torres-Cruz has gone through this script in both English and Spanish. “It’s worse for me in Spanish,” she says. “I don’t know if it’s because Spanish is my native language, but it just makes me cringe every time that I say the phrase that ‘the man involved is liable.’ It’s horrible in Spanish, it just sounds worse.”
Phone advocates are given the leeway to explain that what they are reading is a state-mandated script, and give their clients a chance to get clarity on the actual risks and side effects of abortion. “Every time that I finish reading that script I always encourage them to ask me questions and not just leave that empty space of awkwardness, so at least I can catch any worries they have or any concerns,” says Torres-Cruz. “Because if they ask me [questions], I can clarify” — and, hopefully, allay any lingering fears clients might have about the safety of their upcoming abortions.
In some cases, the callers don’t need that reassurance: “I actually had a patient, while I was reading [a Woman’s Right to Know], just bust out laughing,” says Lucian. “They make abortion out to be this big scary thing: ‘You’re going to bleed to death, you’re going to have all these complications.’ The caller just started laughing, because she’s like, ‘This is so ridiculous. Pregnancy is way more difficult.’”
As painful as complying with the Woman’s Right To Know Act can be, it can be taken care of over the phone at any time. In contrast, the Pennsylvania Abortion Control Act (PACA) requires that pre-abortion counseling be conducted by a physician 24 hours before an abortion is performed. Though the Women’s Center is also able to conduct those sessions over the phone, the calls require a great deal of scheduling and logistics to meet the 24-hour window. Because the phone call is legally mandated, missing it can throw a well-planned abortion appointment into disarray.
“Who knows, the [client] might not have a phone when it comes time for the phone call,” says Jones. “We have a lot of patients who miss the phone call, so we have to reschedule everything because of that.”
Rescheduling that appointment isn’t an easy task for many people. “They already took off work, they already found childcare, they already have everything set up” to ensure they could make their original appointment, Lucian says. And yet with one missed call, “all that work the patient did to set up that appointment is now out the window.”
Ebaben, 27, started working at the Advocacy Center in May 2019. In the months he’s been a phone advocate, he’s received an advanced education in the struggles faced by people looking to have an abortion. “I knew going into it, I would be dealing with heavy subjects. But I didn’t realize to what extent,” he says.
Ebaben has spoken with people who are preparing to drive four or five hours just to get to their appointments. He’s spoken with sexual assault survivors and people recovering from drug addiction. He’s also counseled people who accidentally found themselves at the offices of anti-abortion activists masquerading as health care providers, also known as crisis pregnancy centers.
There’s a call in particular that has stuck with him. “It was kind of devastating,” he says, explaining that the woman in question had just extricated herself from a domestic violence situation. “She was crying, she didn’t know what she was going to do, she had nowhere to stay, but she needed the abortion, because the abuser is who impregnated her.”
As Ebaben talked with the caller, providing her with resources for domestic violence organizations in her area, she revealed that she did not have the funds to pay for her abortion. “I was like, ‘Look, we want you to come in regardless of how much money you have. You can leave that to me to figure out.’” That simple gesture — an everyday part of a phone advocate’s work — overwhelmed the woman on the other end of the phone. “She started crying and was like, ‘You saved my life,’” Ebaben recalls.
“It was a profound moment for me,” he tells me. “To me, it’s just my job. To that one individual client, maybe that is saving their life.”